Related Experiment Video
Updated: Dec 24, 2025
Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain
Published on: May 16, 2025
Treating juvenile idiopathic arthritis to target: what is the optimal target definition to reach all goals?
Casper G Schoemaker1,2,3, Joost F Swart4,5, Nico M Wulffraat4,5
1Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KC.03.063.0, P.O. box 85090, 3508, AB, Utrecht, The Netherlands. C.G.Schoemaker-4@umcutrecht.nl.
Insights
Juvenile Idiopathic Arthritis (JIA) treatment needs broader targets beyond inactive disease. Shared decision-making empowers patients and parents in setting personal JIA treatment goals for better outcomes.
Area of Science:
- Pediatric Rheumatology
- Clinical Trial Design
- Patient-Centered Care
Background:
- International Task Force recommendations for Juvenile Idiopathic Arthritis (JIA) treatment to target (T2T) were established in 2018.
- Key issues remain unresolved: defining a singular "best" target, validating the "domino effect" of T2T on all symptoms, and integrating shared decision-making.
Discussion:
- The lack of a specific instrument for assessing inactive disease or remission necessitates a broad target definition in JIA management.
- The assumption that aggressive T2T treatment positively impacts all goals (pain, fatigue, stiffness) requires further confirmation.
- Shared decision-making is crucial, emphasizing the active role of patients and parents in selecting personal treatment targets for JIA.
Key Insights:
- Restructuring electronic medical records to display personal patient goals and target dates facilitates individualized JIA treatment strategies.
- Visualizing personal goals enhances meaningful discussions between clinicians, patients, and parents, promoting shared decision-making in JIA care.
- A joint T2T strategy for JIA is promising but requires incorporating patient-defined goals beyond just achieving inactive disease.
Outlook:
- Future JIA treatment strategies should focus on a comprehensive T2T approach that actively involves patients and parents in target setting.
- Further research is needed to validate the impact of T2T on all JIA symptoms and to refine assessment tools for inactive disease.
- Integrating patient-reported outcomes and personal goals into T2T frameworks will optimize individualized JIA management and improve patient engagement.
Abstract:
In 2018, an international Task Force formulated recommendations for treating Juvenile Idiopathic Arthritis (JIA) to target. The Task Force has not yet resolved three issues. The first issue is the lack of a single "best" target. The Task Force decided not to recommend the use of a specific instrument to assess inactive disease or remission. Recent studies underscore the use of a broad target definition. The second issue is the basic assumption that a treatment aggressively aimed at the target will have 'domino effects' on other treatment goals as well. Thus far, this assumption was not confirmed for pain, fatigue and stiffness. The third issue is shared decision-making, and the role of individual patient targets. Nowadays, patients and parents should have a more active role in choosing targets and their personal treatment goals. In our department the electronic medical records have been restructured in such a way that the patient's personal treatment goals with a target date appears on the front page. The visualization of their specific personal goals helps us to have meaningful discussions on the individualized treatment strategy and to share decisions. In conclusion, a joint treat to target (T2T) strategy is a promising approach for JIA. The Task Force formulated valuable overarching principles and a first version of recommendations. However, implementation of T2T needs to capture more than just inactive disease. Patients and parents should have an active role in choosing personal targets as well.
Related Concept Videos
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:26Targets for Drug Action: Overview
Receptors are either membrane-spanning or intracellular proteins, which upon binding a ligand, get activated and transmit the signal downstream to elicit a response. Drugs bind receptors, either mimicking the action of endogenous ligands or blocking the receptor activity to bring about a modified response. Nearly 35% of approved drugs target the G...
01:26Psychosis: Goals of Pharmacotherapy
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:21Rheumatic Heart Disease III: Medical Management
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...